Collaborative arrangements and privately practising nurse practitioners in Australia: results from a national surveyJane Currie A B , Mary Chiarella A and Thomas Buckley A
B Corresponding author. Email: firstname.lastname@example.org
Australian Health Review - http://dx.doi.org/10.1071/AH16051
Submitted: 24 February 2016 Accepted: 26 July 2016 Published online: 9 September 2016
Objective Since the introduction of legislative changes in 2010, services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for subsidisation through the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). To provide eligible services, PPNPs must collaborate formally with a medical practitioner or an entity that employs medical practitioners. This paper provides data from a national survey on these collaborative arrangements in Australia. The aim of the study was to evaluate the impact of PPNP services on patient access to care in Australia.
Methods PPNPs in Australia were invited to complete an electronic survey. Quantitative data were analysed using descriptive statistics, whereas qualitative data were analysed using thematic analysis. Seventy-three surveys were completed.
Results Ninety-three per cent of participants reported having a collaborative arrangement in place. Frequency of communication ranged from daily (27%) to never (1%). Participants reported that collaborative arrangements facilitate learning, patient care and offer support to PPNPs. However, for some PPNPs, organising a formal collaborative arrangement is demanding because it is dependent on the availability and willingness of medical practitioners and the open interpretation of the arrangement. Only 19% of participants believed that collaborative arrangements should be a prerequisite for PPNPs to access the MBS and PBS.
Conclusion Although there are benefits to collaborative arrangements, there is also concern from PPNPs that mandating such arrangements through legislation presents a barrier to establishing PPNP services and potentially reduces patient access to care. Collaboration with medical practitioners is intrinsic to nursing practice. Thus, legislating for collaborative arrangements is unnecessary, because it makes the normal abnormal.
What is known about the topic? To access the MBS and PBS, PPNPs are required by law to have a collaborative arrangement with a medical practitioner or entity that employs medical practitioners. To date, the effects of these collaborative arrangements on PPNP services in Australia have not been known.
What does the paper add? This paper provides unique data from a national survey on collaborative arrangements between PPNPs and medical practitioners in Australia.
What are the implications for practitioners? Although there are benefits to collaborative arrangements, there is also concern that mandating such arrangements presents a barrier to establishing PPNP services and potentially reduces patient access to care.
Additional keywords: primary health care, nurse-led clinics.
References Currie J, Chiarella M, Buckley T. Preparing a realist evaluation to investigate the impact of privately practising nurse practitioner services on patient access to care in Australia. Int J Nurs 2015; 2 1–10.
 Currie J, Chiarella M, Buckley T. Workforce characteristics of privately practising nurse practitioners in Australia. Results of a national survey. J Am Acad Nurs Pract 2016,;
| Workforce characteristics of privately practising nurse practitioners in Australia. Results of a national survey.CrossRef |
 Harvey C. Legislative hegemony and nurse practitioner practice in rural and remote Australia. Health Sociol Rev 2011; 20 269–80.
| Legislative hegemony and nurse practitioner practice in rural and remote Australia.CrossRef |
 National Health and Hospitals Reform Commission. A healthier future for all Australians, final report June 2009. 2009. Available at: http://www.health.gov.au/internet/nhhrc/publishing.nsf/content/nhhrc-report [verified 12 January 2016].
 Cashin A. Collaborative arrangements for Australian nurse practitioners: a policy analysis. J Am Acad Nurs Pract 2014; 26 550–4.
 Australian Medical Association. Collaborative arrangements: what you need to know. 2010. Available at: https://ama.com.au/sites/default/files/documents/Collaborative_Arrangements_What_you_need_to_know.pdf [verified 22 December 2015].
 Department of Health Australia. Collaborative arrangements for participating midwives and nurse practitioners. 2012. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/midwives-nurse-pract-collaborative-arrangements [verified 1 December 2015].
 Australian Government. National health (collaborative arrangements for nurse practitioners). Determination (Cth). 2010. Available at: http://www.comlaw.gov.au [verified 1 December 2015].
 Carrigan C. Collaborative arrangements: are expanded roles for nurses and midwives being stifled? Aust Nurs J 2010; 18 24–7.
 Carter M, Owen-Williams E, Della P. Meeting Australia’s emerging primary care needs by nurse practitioners. J Nurse Pract 2015; 11 647–52.
| Meeting Australia’s emerging primary care needs by nurse practitioners.CrossRef |
 Australian Government Department of Health. Pharmaceutical Benefits Scheme. Section 100 highly specialised drugs program. Available from: http://www.pbs.gov.au/info/browse/section-100/s100-highly-specialised-drugs [verified 15 January 2016].
 Currie J, Chiarella M, Buckley T. An investigation of the international literature on nurse practitioner private practice models. Int Nurs Rev 2013; 60 435–47.
| An investigation of the international literature on nurse practitioner private practice models.CrossRef | 1:STN:280:DC%2BC2c%2FltFGjsg%3D%3D&md5=bf9c0dd67db24bc7a5bb99290258c7d7CAS | 24131230PubMed |
 Pawson R, Tilley N. Realistic evaluation. London: Sage; 1997.
 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3 77–101.
| Using thematic analysis in psychology.CrossRef |
 McCaffrey R, Hayes R, Stuart W, Cassell A, Farell C, Miller-Reyes C. Program to improve communication and collaboration between nurses and medical residents. J Contin Educ Nurs 2010; 41 172–8.
| Program to improve communication and collaboration between nurses and medical residents.CrossRef | 20411889PubMed |
 Zwarenstein M, Goldman J, Reeves S, Interprofessional collaboration Effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2009; 3 CD000072
| Effects of practice-based interventions on professional practice and healthcare outcomes.CrossRef | 19588316PubMed |
 Cowan M, Shapiro M, Hays R, Abdelmonem A, Vazirani S, Ward C, Ettner S. The effect of a multidisciplinary hospitalist/physician and advanced practice nurse collaboration on hospital costs. J Nurs Admin 2006; 36 79–85.
| The effect of a multidisciplinary hospitalist/physician and advanced practice nurse collaboration on hospital costs.CrossRef |
 Desborough J, Parker R, Forrest L. Nurse satisfaction with working in a nurse led primary care walk-in centre: an Australian experience. Aust J Adv Nurs 2013; 31 11–19.
 Desborough J. How nurse practitioners implement their roles. Aust Health Rev 2012; 36 22–6.
| How nurse practitioners implement their roles.CrossRef | 22513015PubMed |
 Legault F, Humbert J, Amos S, Hogg W, Ward N, Dabrouge S, Ziebell L. Difficulties encountered in collaborative care: logistics trumps desire. J Am Board Fam Med 2012; 25 168–76.
| Difficulties encountered in collaborative care: logistics trumps desire.CrossRef | 22403197PubMed |
 Main R, Dunn N, Kendall K. Crossing professional boundaries: barriers to the integration of nurse practitioners in primary care. Educ Prim Care 2007; 18 480–7.
| Crossing professional boundaries: barriers to the integration of nurse practitioners in primary care.CrossRef |
 Bailey P, Jones L, Way D. Family physician/nurse practitioner: stories of collaboration. J Adv Nurs 2006; 53 381–91.
| Family physician/nurse practitioner: stories of collaboration.CrossRef | 16448481PubMed |
 Schadewaldt V, McInnes E, Hiller J, Gardner A. Investigating characteristics of collaboration between nurse practitioners and medical practitioners in primary healthcare: a mixed methods multiple case study protocol. J Adv Nurs 2014; 70 1184–93.
| Investigating characteristics of collaboration between nurse practitioners and medical practitioners in primary healthcare: a mixed methods multiple case study protocol.CrossRef | 24138114PubMed |
 MacLellan L, Higgins I, Kevtt-Jones T. Medical acceptance of the nurse practitioner role in Australia: a decade on. J Am Acad Nurs Pract 2015; 27 152–9.
 DeGuzman A, Ciliska D, DiCenso A. Nurse practitioner role implementation in Ontario public health units. Canad J Pub Hlth 2010; 101 309–13.
 Fletcher C, Baker S, Copeland L, Reeves P, Lowery J. Nurse practitioners’ and physicians’ views of NPs as providers of primary care to veterans. J Nurs Schol 2007; 39 358–62.
| Nurse practitioners’ and physicians’ views of NPs as providers of primary care to veterans.CrossRef |
 Stantik-Hutt J, Newhouse R, White M, Johantgen M, Bass E, Zangaro G, Wilson R, Fountain L, Steinwachs DM, Heindel L, Weiner JP. The quality and effectiveness of care provided by nurse practitioners. J Nurse Pract 2013; 9 492–500.
| The quality and effectiveness of care provided by nurse practitioners.CrossRef |
 Dinh M, Walker A, Parameswaran A, Enright N. Evaluating the quality of care delivered by an emergency department fast track unit with both nurse practitioners and doctors. Australas Emerg Nurs J 2012; 15 188–94.
| Evaluating the quality of care delivered by an emergency department fast track unit with both nurse practitioners and doctors.CrossRef | 23217651PubMed |
 Jennings N, O’Reilly G, Lee G, Cameron P, Free B, Bailey M. Evaluating outcomes of the emergency nurse practitioner role in a major urban emergency department, Melbourne Australia. J Clin Nurs 2008; 17 1044–50.
| Evaluating outcomes of the emergency nurse practitioner role in a major urban emergency department, Melbourne Australia.CrossRef | 18321270PubMed |
 Nursing and Midwifery Board of Australia. Registered Nurse Standards for Practice. 2016, June 1. Available at: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx [verified 8 August 2016].